Fit for Duty: Lessons Learned from Outpatient and Homebound Hematopoietic Cell Transplantation to Prepare Family Caregivers for Home-Based Care

In the past decade, the demand for home-based care has been amplified by the Coronavirus disease 2019 pandemic. Home-based care has significant benefits for patients, their families, and healthcare systems, but it relies on the often-invisible workforce of family and friend caregivers who shoulder essential health care responsibilities, frequently with inadequate training and support. Hematopoietic cell transplantation (HCT), a potentially curative but intensive treatment for many patients with blood disorders, is being increasingly offered in home-based care settings and necessitates the involvement of family caregivers for significant patient care responsibilities. However, guidelines for supporting and preparing HCT caregivers to effectively care for their loved ones at home have not yet been established. Here, informed by the literature and our collective experience as clinicians and researchers who care for diverse patients with hematologic malignancies undergoing HCT, we provide considerations and recommendations to better support and prepare family caregivers in home-based HCT and, by extension, family caregivers supporting patients with other serious illnesses at home. We suggest tangible ways to screen family caregivers for distress and care delivery challenges, educate and train them to prepare for their caregiving role, and create an infrastructure of support for family caregivers within this emerging care delivery model.

Coping, mood, and aspects of personality in Spanish translation and evidence of convergence with English versions

Research on stress and its influence on health and well-being has flourished for several decades, examining as predictors such psychosocial variables as personality and coping. This work now often targets multiethnic samples. Because many potential participants lack facility in English, a need exists for translations of measures into other languages. We translated 6 instruments into Spanish and studied their characteristics. Of these, 3 were measures of personality qualities: the Life Orientation Test--Revised (Scheier, Carver, & Bridges, 1994), the Behavioral Inhibition/Behavioral Activation Scales (Carver & White, 1994), and the Measure of Body Apperception (Carver et al., 1998). The others were the Brief COPE (Carver, 1997), the Center for Epidemiological Studies--Depression Scale (Radloff, 1977), and an abbreviated version of the Profile of Mood States (McNair, Lorr, & Droppelman, 1971). Correlations between English and Spanish versions in bilingual samples were all above. 72, except for the COPE's Behavioral Disengagement scale. Alpha reliabilities of the Spanish versions were comparable to those of the English versions. Correlations among measures in a sample of cancer patients were similar across languages.

The psychosocial aspects of breast cancer

Few issues prepare women to cope with the multitude of problems that confront them when diagnosed with breast cancer. The provision of appropriate treatment requires that health care professionals attend to the emotional, social, and other nonmedical functioning of the woman and her family. Nurse practitioners play a central role in the delivery of medical care. This article describes the typical response of women to breast cancer and factors associated with risk for the development of comorbid psychological and adjustment problems. Pragmatic suggestions to guide nurse practitioners in assisting patients and their families cope with breast cancer are provided, as well as indicators for referral to a mental health professional.

Concern about aspects of body image and adjustment to early stage breast cancer

OBJECTIVE

Several authors have suggested that patients adjust more poorly to breast cancer if they are heavily invested in body image as a source of their sense of self-worth. This prospective study examined this possibility, looking at two aspects of concern about body image as predictors of several indices of adjustment over the first postoperative year.

METHODS

At diagnosis (and again a year later) 66 women with early stage breast cancer reported how much they valued a) a sense of body integrity (or intactness) and b) a good physical appearance. The day before surgery, a week afterward, and at 3-month, 6-month, and 12-month follow ups, they reported on their mood. At presurgery and at follow ups they also rated their attractiveness and sexual desirability and reported on frequency of sexual interaction. At follow-ups they also indicated how much their illness and treatment were interfering with social and recreational activities.

RESULTS

Initial investment in appearance was related to distress across the postsurgical year. In contrast, investment in appearance made women more resilient against deterioration in their perceptions of attractiveness. Concern about body integrity did not strongly predict emotional distress, but it related to adverse impact on social and recreational activities in the follow-up period, to deterioration in feelings of sexual desirability, and to feelings of alienation from the self (feeling "not like yourself anymore").

CONCLUSIONS

Body image is often thought of in terms of physical appearance, but there is also a body image pertaining to integrity, wholeness, and normal functioning. People who are greatly concerned about either aspect of their body image are vulnerable to poorer psychosocial adjustment when confronting treatment for breast cancer. The poorer adjustment takes a different form, however, depending on the nature of the patient's body-image concern.

Optimism versus pessimism predicts the quality of women's adjustment to early stage breast cancer

BACKGROUND

Recent studies indicate that breast cancer patients do not usually experience the devastating psychological consequences once viewed as inevitable. However, some adjust to the disease more poorly than others. This study examined the personality trait of optimism versus pessimism as a predictor of adjustment over the first year, postsurgery.

METHODS

Seventy women with early stage breast cancer reported on their general optimism-pessimism at diagnosis. One day before surgery, and at 3-month, 6-month, and 12-month follow-ups, they reported their subjective well-being (mood scales and a measure of satisfaction with life). At follow-ups, they also rated their sex lives, indicated how much physical discomfort was interfering with their daily activities, and reported on thought intrusion.

RESULTS

Pessimism displayed poorer adjustment at each time point by all measures except interference from pain. Even controlling for previous well-being, pessimism predicted poorer subsequent well-being, suggesting that pessimism represents a vulnerability to a negative change in adjustment. In contrast, effects of pessimism on quality of sex life and thought intrusion were not incremental over time. Additional analyses indicated that effects of the optimism-pessimism measure were captured relatively well by a single item from the scale.

CONCLUSIONS

A sense of pessimism about one's life enhances a woman's risk for adverse psychological reactions to the diagnosis of, and treatment for, breast cancer. This finding suggests the potential desirability of assessing this quality informally in patients, to serve as a warning sign regarding the patient's well-being during the period surrounding and following surgery.